Transcript Possible answers for Handout 14.1

1
Situation
1. Madge
1. Wanders street, screams obscenities,
has lucid moments, disordered thinking
2. Schizophrenia – illogical thought,
difficulty deciphering real and imagined,
abnormal emotions
3. Not good - symptoms likely get worse to
the point of suicide
4. Hospitalized during episodes –
antipsychotic meds – support programs
(family and friends, etc.), and behavioral
therapies
2
Situation
2. Kurt
1. Excessive mood swings, very productive
vs. withdrawn
2. Bipolar Disorder –back and forth between
periods of a very good or irritable mood
and depression.
3. Suicide is a very real risk during both mania
and depression. People with bipolar
disorder or think or talk about suicide need
immediate emergency attention.
4. Mood-stabilizing medication – Support
programs and therapy –support for family
and from family to person with BD
3
Situation
3. Gwen
1. Scared by dog as a child – traumatic event
2. Phobia – due to irrational fear and lifechanging behavior exhibited
3. Some get better without treatment, but
most get progressively worse
4. Childhood (& brother) may suggest
psychoanalytic, but this seems to be a
case for systematic desensitization –
slowly introduce fear producing objects to
gradually relieve anxiety.
4
Situation
4. Family
1. A lot of problems – Dan’s alcoholism and
Lisa’s depression, but focus should be on
miscommunication and dysfunctionality of
the family
2. Alcoholism, depression, family problems
3. Unlikely to get better without treatment
4. Family therapy – Along with AA for Dan
and one of the insight therapies for Lisa –
Family needs skills to communicate and
support one another
5
Situation
5. Cindy
1. Feels worthless, reality doesn’t match
perception – Blames herself to extremes
2. Low self-esteem, maybe depression
3. May learn to deal with irrational thoughts
with support from others, but not likely to
get much better without help.
4. Cognitive therapy, such as RET – would
aim to change her irrational thoughts into
more realistic views
Situation
6
One day, Karl, a native of Hawaii, wakes up
in Nebraska, with no memory of who he
is, how he got there, or from where he
came. He has never been a drug user,
and has not suffered from any head
trauma. Karl has no ability to discuss his
childhood or produce any articles from
his distant past. He has no social
security documentation, and has no
contact with any family members.
6. Karl
1. Karl seems to have the inability to remember his past. It’s
almost as if he’s started a new life.
2. Dissociative Fugue – Because Karl has a type of
amnesia that is unlike retroactive amnesia, in that he has
no obvious signs of illness or injury.
3. Prognosis - The DSM-IV-TR states that the fugue may
have a duration from hours to months and recovery is
usually rapid. However, some cases may be
unmanageable. An individual usually only has a single
episode.
4. The goal of treatment is to help the person come to
terms with the stress or trauma that triggered the fugue.
Treatment also aims to develop new coping methods to
prevent further fugue episodes. The best treatment
approach depends on the individual and the severity of
his or her symptoms, but most likely will include some
combination of the following treatment methods: 
• Psychotherapy
– main treatment for dissociative disorders.
– designed to encourage communication of conflicts and increase
insight into problems.
• Cognitive therapy
– Focus on changing dysfunctional thinking patterns and resulting
feelings and behaviors.
• Medication
– no medication to treat the dissociative disorders
– Sufferers may also have depression or anxiety & might benefit from
meds
• Family therapy
– to teach the family about the disorder and its causes, & recognize
symptoms of a recurrence.
• Creative therapies (art therapy, music therapy)
– allow the patient to explore and express thoughts and feelings in a
safe and creative way.
• Clinical hypnosis
– allows people to explore thoughts, feelings and memories they
might have hidden from their conscious minds.
– The use of hypnosis for treating dissociative disorders is
controversial due to the risk of creating false memories.
Situation
7
Julio believes he is an alien who has been left
behind on Earth by his “pod.” He is often
difficult to understand, because he speaks
frequently in rhyme and makes up his own
words to communicate with his alien friends.
Julio regularly walks around wearing only a
tube top, particularly when it’s cold outside,
and has terrible personal hygiene. He insists
on eating in the dark and rarely shows any
kind of emotion.
7. Julio
1. Irrational thinking, very disorganized and
confusing behavior
2. Disorganized Schizophrenia – by observing his
behavior as illogical and irrational and his
emotions are limited. It is recommended to use
certain tests to be sure there is not some
underlying health condition that’s causing the
problems.
3. DS does not get better without treatment –
patient may end up harming themselves or
others if untreated.
4. Schizophrenia treatment involves medications
and therapy to reduce the risk of future psychotic
episodes and improve relationships. ECT is also
used.
Situation
8
Steve appears to be a mild-mannered 20something, but he sometimes believes he is a
teenage female named “Suzy” who is a
member of a high school dance team. At these
times, he dresses in various matching outfits,
carries pom-poms, and practices various
dance routines. Steve is confused about why
he sometimes awakens dressed in strange
clothing. It has recently come to light that
Steve was physically abused, and possibly
sexually abused, as a child by his step-father.
8. Steve
1.
2.
3.
4.
Physical and possible sexual abuse as a child – “normal”
male behaviors along with different identity (Suzy)
Dissociative Identity Disorder – Dissociation is recognized as
a symptomatic presentation in response to psychological
trauma, extreme emotional stress, and, as noted, in
association with emotional dysregulation and borderline
personality disorder.
DID does not resolve spontaneously, and symptoms vary
over time. Individuals still attached to abusers face the
poorest prognosis. Individuals with the condition commonly
attempt suicide.
There is a general lack of consensus in the diagnosis and
treatment of DID. Common treatment methods include an
eclectic mix of psychotherapy techniques, including cognitive
behavioral (CBT) and insight-oriented therapies, as well
as medications.
Situation
9
Driving back from a concert, Gerri fell asleep at the wheel
and crashed her Jaguar convertible. Her best friend
perished in the crash. Ever since, although doctors can
find nothing physically wrong, Gerri has been
paralyzed in the arm with which she was steering, and
cannot mover her right foot. Gerri’s doctors accuse her
of making up her symptoms, but Gerri is adamant that
she is paralyzed. Gerri doesn’t seem very concerned
with the paralysis, and is now exhibiting fewer
behaviors associated with her previously diagnosed
anti-social personality disorder.
9. Gerri
1.
2.
3.
4.
Accident preceded “paralysis” of which there is no physical
connection
Conversion Disorder – a condition in which a person has
blindness, paralysis, or other nervous system (neurologic)
symptoms that cannot be explained by medical evaluation,
often developing after a stressful experience – it’s also
common for the symptoms of another, previously
diagnosed mental disorder to become less prominent (less
symptoms)
Symptoms usually last for days to weeks and may
suddenly go away. Usually the symptom itself is not life
threatening, but complications can be debilitating.
Psychotherapy and stress management training may help
reduce symptoms. The affected body part or physical
function will need physical or occupational therapy until the
symptoms disappear. For example, paralyzed limbs must
be exercised to prevent muscle wasting.
Situation
10
Keshona is terrified of speaking in public and
attending social gatherings. Although highly
knowledgeable and competent, whenever she
has to address a gathering of adults, her heart
pounds, she feels nauseous, trembles, and her
mouth gets dry. Keshona has some awareness
of her problem, sharing her fear of potential
scrutiny or judgment with her closest friends.
Keshona rarely goes out of the house, and has
an irregular attendance pattern at work. She
has begun to drink alcohol often, particularly
when faced with social situations.
10. Keshona
1.
2.
3.
4.
Terrified of social situations – not lack of ability –
incapacitating
Social Phobia – she fits the criteria – and it’s interfering
with normal function - different from shyness. Shy people
are able to participate in social functions. People with
social phobia are constrained by their condition to the
point that it affects their ability to function in work and
relationships.
Typically will get worse
The goal of treatment is to help you function effectively.
The success of the treatment usually depends on the
severity of the phobia.
• Medications, behavioral treatment, cognitive
behavioral therapy, systematic desensitization,
social skills training, role playing and modeling, &
lifestyle changes.
Situation
11
Frank has been arrested on numerous occasions for
disturbing the peace and for illegally producing and
selling alcohol and drugs to minors. Although a number
of his clients have died from overdoses, he feels no
remorse. Frank has been arrested many times, starting
15 years ago when he was caught using firecrackers to
blow up frogs near the creek by his parent’s farm.
Needless to say, Frank was always in trouble during his
school years, even getting kicked out of high school as
a 10th grader and being forced to complete his
education at the local adult school. Frank has a very
charming personality, which he uses to manipulate
others to get what he wants. However, when he doesn’t
get what he wants, he becomes violent. His most
recent arrest was for fighting with (hitting) his Dad
because he wanted to “borrow” money and his Dad
said no. It’s likely that Frank was abused as a child, but
he refuses to acknowledge much of his childhood
11. Frank
1. Arrested often – no remorse – hit Dad
2. Antisocial personality disorder – long-term
pattern of manipulation, and criminal activity
3. Symptoms tend to peak in late teens/early 20s.
Imprisonment, drug abuse, violence and suicide
are all likely outcomes.
4. Antisocial personality disorder is one of the most
difficult personality disorders to treat. People with
this condition rarely seek treatment on their own.
They may only start therapy when required to by
a court. The effectiveness of treatment for
antisocial personality disorder is not known.
Treatments that show the person the negative
consequences of illegal behavior seem to hold
the most promise (Cognitive).
Situation
12
A couple of months ago, while she was on a visit to the
Florida, Samantha’s hotel was demolished by a
hurricane while she took refuge in a storm shelter.
Ever since, she has been plagued by terrible
nightmares and occasional flashbacks, in which she
truly feels like she is experiencing the hurricane all
over again. In fact, she finds herself become very
agitated when she learns that rain is in the forecast.
Friends have noticed that Samantha has displayed an
emotional “numbness,” and a general lack of interest in
normal activities. She doesn’t want to hang out with
the 2 friends with whom she went to Florida, and can’t
even order her favorite drink because it comes with a
cocktail umbrella.
12. Samantha
1. Hurricane – trauma – becoming withdrawn
2. PTSD – lasted more than 30 days,
affecting normalcy, traumatic event
triggered
3. Likely to persist without treatment, but
memories and severity of PTSD should
fade over time.
4. Early treatment can help prevent PTSD.
Good social support system is helpful.
Desensitization shows promise.
Situation
13
During early adolescence, Don became addicted
to cigarettes, alcohol, and eventually
marijuana. Now in his early 20s, Don has
periods of time where he doesn’t sleep much,
gets angry easily, is promiscuous, launches
new get-rich-quick schemes, and goes on
gambling sprees. During these times in his life,
he feels invincible, on top of the world, like he
can’t lose. At other times, he feels like a loser,
finds no joy in activities he used to enjoy, and
is so down that he can’t even get out of bed.
Life seems purposeless. Don has attempted
suicide at least twice in the past 2 years.
13. Don
Drug use in past – promiscuous – up and down
emotionally
2. Bipolar Disorder – Mood swings, up and down nature
of behavior, instability
3. Most don’t get better without treatment, and periods of
depression or mania return in most patients, even with
treatment. Suicide is a real possibility without
treatment.
4. Drugs, called mood stabilizers, are usually used first
– The main goals of treatment are to:
• Avoid moving from one phase to another
• Avoid the need for a hospital stay
• Help the patient function as well as possible
between episodes
• Prevent self-injury and suicide
• Make the episodes less frequent and severe
1.
Situation
14
No matter what he is doing, Ikimba always feels a
little tense. The apprehension has no apparent
cause, and he seems to feel stressed about
“everything.” In fact, Ikimba experiences
constant uneasiness during weekends and
vacations. He has shared that he is always
nervous and tired, has difficulty concentrating,
and is startled easily. When Ikimba resolves
one issue, several more seem to crop up. For
example, he recently inherited a large sum of
money, and now he’s nervous about what to do
with the money and stressed about meeting
his roommate’s girlfriend later this week.
14. Ikimba
1. Over-stressed, trouble concentrating, startled
easily
2. Generalized Anxiety Disorder – b/c Ikimba has
frequent, constant worry/anxiety over many
different things
3. If untreated, may not improve – may get worse –
can be debilitating, but wide range of effects
4. Medicine and CBT
•
•
SSRI, SNRI (antidepressants)
Cognitive-behavioral therapy helps you understand
your behaviors and how to gain control of them
Situation
15
Ken is plagued by constant worries that what he
has planned will not occur as scheduled. He
makes hundreds of to-do lists each day and
often checks these lists to make sure they are
correct. Ken incessantly reminds his
colleagues of upcoming deadlines, sometimes
15 or 20 times each day. Often, Ken is aware
of the incessant thoughts, but he is
overwhelmed with the feeling that he must “do
it.” Ken has been declared physically healthy
by his primary physician and does not use
drugs of any kind.
15. Ken
1. Ken has repeated unwanted thoughts and
feelings and is driven to “do it.”
2. Obsessive Compulsive Disorder – unwanted,
repeated – no physical illness or drug use –
aware of problem, but can’t control it
3. OCD is a long-term (chronic) illness with
periods of severe symptoms followed by times
of improvement. However, a completely
symptom-free period is unusual. Most people
improve with treatment.
4. medications and therapy
•
•
SSRIs or TCAs (antidepressants)
CBT
16
Situation
Trent was raised in a rural, isolated area.
Interactions with members of the opposite sex
were minimal. Now Trent can be sexually
aroused only by farm animals or someone
dressed up as a farm animal. He has not had
sex with animals, yet, but he fantasizes of a
day where his preference is socially accepted.
He has his bedroom decorated to look like the
prototypical dairy farm and works as a
handyman at the local sheep farm. He has had
girlfriends in the past, but they break up with
him not long after he requests they dress up as
a cow, sheep, or rooster.
16. Trent
1. Lack of female contact as child – only
sexually aroused by a specific, abnormal
situation
2. Fetishism – due to the fixation on farm
animals, Trent has conflict with potential
partners.
3. Sometimes fetish disappears and no
treatment is needed – Other times it can
get worse (more extreme)
4. CBT, medication, and/or psychoanalysis
•
Meds to reduce testosterone or estrogen